Toxic leukoencephalopathy

Toxic leukoencephalopathy is an encephalopathy predominantly affecting white matter as a result of a toxic substance. The presentation can either be chronic or acute. In the acute phase, acute toxic leukoencephalopathy can have a characteristic and profound MR imaging appearance that is potentially reversible with therapy or removal of the offending agent.

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Clinical presentation

The clinical presentation of toxic leukoencephalopathy is extremely variable, ranging from minor cognitive impairment, easily confused with psychiatric illnesses, to severe neurological dysfunction. The lack of imaging in patients with minimal or mild encephalopathic symptoms may account for why this entity may be underdiagnosed in the acute phase.

Pathology

Aetiology

There are numerous agents implicated in toxic leukoencephalopathy. These include: